- JOP. 2008 Mar 8;9(2):91-8.
there a standard of care for the management of advanced pancreatic
cancer?. Highlights from the Gastrointestinal Cancers Symposium.
Orlando, FL, USA. January 25-27, 2008.
Yale Cancer Center, Yale University School of Medicine. New Haven, CT, USA.
advances in our understanding of the molecular and genetic basis of
pancreatic cancer, the outcome for this disease remains dismal.
Gemcitabine, the standard chemotherapy for pancreatic cancer, offers
modest improvement of tumor-related symptoms and marginal advantage of
survival. Many chemotherapeutic and targeted agents have been pitted
against or combined with gemcitabine in randomized phase III trials and
no drug was shown to be superior to single-agent gemcitabine except two
gemcitabine-containing combinations: capecitabine plus gemcitabine vs.
gemcitabine and erlotinib. In this article, the author debates: "Is
there a standard of care for the treatment of advanced pancreatic
cancer?". In addition, he summarizes the key studies presented at the
"Gastrointestinal Cancers Symposium" held in Orlando, FL, USA on
January 25-27, 2008. The studies discussed here include the following:
i) a phase I study of a chemotherapy doublet gemcitabine plus
capecitabine, combined with a biologic doublet (bevacizumab plus
erlotinib) in patients with advanced pancreatic adenocarcinoma
(abstract #141); ii) a phase II study of gemcitabine, bevacizumab, and
erlotinib in locally advanced and metastatic adenocarcinoma of the
pancreas (abstract #151); iii) final results of the multicenter phase
II study on gemcitabine, capecitabine, and bevacizumab in patients with
advanced pancreatic cancer (abstract #198); iv) interim results from a
phase II study of volociximab in combination with gemcitabine in
patients with metastatic pancreatic cancer (abstract #142); v) a pilot
study of combination chemotherapy with S-1 and irinotecan for advanced
pancreatic cancer (abstract #155); vi) a multicenter phase II study of
gemcitabine and S-1 combination chemotherapy in patients with
unresectable pancreatic cancer (abstract #212); vii) a phase I/II study
of PHY906 plus capecitabine in patients with advanced pancreatic
carcinoma (abstract #260); and viii) the final results of a phase II
trial of Genexol-PM(R), a novel cremophor-free, polymeric micelle
formulation of paclitaxel in patients with advanced pancreatic cancer
(abstract #269). Based on the results presented at the meeting, it
comes to us that patients with locally advanced vs. metastatic
pancreatic cancer should be studied separately, better understanding of
the biology of pancreatic cancer is mandatory and evaluation of novel
agents is crucial. We, as oncologist, have to change our attitudes
towards clinical trials and need to think beyond a trial design such as
gemcitabine vs. drug of our choice.